Causes, Treatment and Prevention Case 4

The presence of gram-negative bacteria, such as Porphyromonas gingivalis, is one of the identifying factors in periodontal disease, however there are several risk factors to consider. Poor oral hygiene plays a significant role in the development and progression of periodontal disease, but there are also links between oral health and systemic health. For example, there are cases of bacterial infections (such as bacterial endocarditis) caused by transmission of bacteria into the bloodstream during dental procedures. There are also conditions that can affect oral health, such as pregnancy gingivitis/pyogenic granuloma and diabetes related problems. In addition, there is evidence-based research that shows a link between family history and periodontal disease markers. It is just as important to identify risk factors, as precursors to developing periodontal disease, as it is to treat active disease.

Treatment for periodontal disease must be individualized for each patient. To track the progress of patients, data is collected and compared during appointments. A specialized periodontal chart allows dental professions to record this data for easy comparison.

There are different types of treatment available for the periodontal patient depending on the severity of the disease and how rapidly it is progressing. There are two types of therapy for periodontal disease: non-surgical therapy (may be referred to as initial therapy), and surgical therapy (which includes such things as grafts, flaps and other surgical procedures). Initial therapy for most patients includes scaling and root planing as well as antimicrobial therapy. This type of therapy is similar in some ways to the oral prophylaxis, but that procedure is preventive and initial therapy is meant to be therapeutic. In scaling and root planing all the calculus is removed and the periodontal pocket is debrided from all deposits and the root surface is smoothed to provide less of an area for attachment of bacteria. Often antimicrobial therapy can be placed in the pocket in hopes of regenerating the attachment of the tissue in the pocket at a higher level and thus decreasing its depth. Nonsurgical procedures are minimally invasive and many times can control the periodontal disease process. Often, local anesthetic to numb the area is required.

Jessica to Mr. Davis: “We have gone over the brushing routine I would like for you to follow, but I want to emphasize flossing. One of the reasons periodontal treatment fails and people lose their teeth is not following through on thorough flossing. Be sure you are following the procedure of wrapping the floss around the tooth in a C shape and cleaning all interproximal surface as deep as you can.”

Dr. Jay to Mr. Davis: “Emmett, since your periodontal disease has progressed, I will be referring you to a periodontist for treatment. Jessica gave you specific oral hygiene instructions about your condition and this brochure is for you to keep. It shows the difference between a healthy mouth and one with periodontal disease. As you can see, in a healthy mouth, the supporting bone level is high and the gum pockets are not very deep. Usually there is very little plaque or calculus. Poor oral hygiene habits cause plaque and calculus to accumulate, and the periodontal disease process begins. Bacterial infection causes the gum pockets to become inflamed, as they were on your last visit. Over time, the tissue begins to atrophy, gums recede, gingival pockets deepen, and the levels of supporting bone decrease. This is why some of your teeth are loose. If untreated, these teeth and others may fall out.”